The application of continuous positive airway pressure in an obstructive sleep apnea syndrome accompanied by subconjunctival hemorrhage secondary to hypertensive episodes: A case report

Introduction: Spontaneous subconjunctival hemorrhage is a common clinical condition associated with hypertension (HT). Although obstructive sleep apnea syndrome (OSAS) is an independent risk factor for HT, it may cause complications. Case Report: A 60-year-old male patient with no bleeding disorders or antiplatelet treatment history presented with subconjunctival hemorrhage after waking up in the morning repeated three times in last two years. He complained of occasional snoring and daytime sleepiness. The body mass index was 30.9 kg/m 2 . He was on antihypertensive medication for 5 years and diagnosed with hypertensive retinopathy by color fundus imaging [figure 1]. A tension Holter monitoring was performed. Day and night rates of systolic and diastolic blood pressures (SBP and DBP) were recorded and classified to be normal, acceptable or critical level [table1]. A polysomnography test revealed OSAS according to apnea-hypopnea index (AHI) to be 45.8. He was given continuous positive airway pressure (CPAP) treatment. After CPAP treatment, tension Holter monitoring showed significantly lower results in SBP, which was 2% at night and 1% at critical level during the day. No recurrence of subconjunctival hemorrhage was observed after CPAP treatment. Conclusion: Recurrent subconjunctival hemorrhages was considered due to hypertensive episodes caused by OSAS in presented case. Due to preventive effects of CPAP treatment on OSAS at night, it should be taken into consideration in complications of hypertension, such as subconjunctival hemorrhage.